Provider Demographics
NPI:1215784251
Name:SPORTSMED PT OF CONNECTICUT PLLC
Entity type:Organization
Organization Name:SPORTSMED PT OF CONNECTICUT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, RCM
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:201-857-0527
Mailing Address - Street 1:266 HARRISTOWN RD STE 304
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3321
Mailing Address - Country:US
Mailing Address - Phone:201-857-0527
Mailing Address - Fax:
Practice Address - Street 1:499B WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4411
Practice Address - Country:US
Practice Address - Phone:475-470-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty